Protocol Change — Help Your Doctors Lead the Charge

(This article is the first in a series about change management that is going on in real time. In addition to making smaller changes in our practices, we are working on some significant transformations right now.)

Getting Started

The first indications that we needed change in our practice showed up in overtime and people missing lunches, which led to a hard look at our workflow. In addition, we discovered we needed to improve on our preventive care compliance, which was great in the spring but fell apart in the summer. Many hospital teams have difficulty with compliance when they are under stress. So, how could we reboot our dedication to improving our workflow and recommit to preventive care?

We recognized that identifying the issues and implementing change should — and must — begin with our doctors' input.

Protocol change can be fairly straightforward if you are working with a single doctor, but the time and effort multiplies the more medical team members there are. It requires face-to-face meeting time, a willingness to examine current workflows, and open communication, all of which can be very challenging in the veterinary practice environment.

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Devote Time to Listening

Managers need to take time to listen, which is harder than we realize. We are getting pulled in many different directions and wearing too many hats. Some days are run in pure survival mode — if a team member comes forward with an idea, all you can think is "not now."

The truth is that change usually occurs only when it has become so stressful that we can't do it the same way anymore. I am certainly guilty of this, but I'm trying to be proactive (whenever I can) about transforming the practice before things go wrong, rather than reacting and patching. If you can't sit down and talk with your doctors about how to make your practice better, you will not be able to drive any meaningful changes. Doctors need to provide the leadership for the medical standard of care in the practice, but managers build the scaffold that makes the vision a reality.

The best way to help doctors drive change is to start with the changes that are important to them. But since it's much easier to listen when you are not being interrupted every two minutes or staring at a desk full of call-back messages, get out of the hospital for the meeting. This needs to be a focused work time. Allow time for everyone to air their frustrations, but get to "what can we do about it?" quickly. Brainstorm realistic solutions that work with what you actually have — not what you could do by adding two experienced veterinary nurses to the team (if you could find them).

How It Worked for Me

I went to lunch with doctors from each team and identified their primary concerns around workflow and their perceptions on priorities moving forward. We also discussed concerns from each team — we needed to limit overtime and make sure that all team members, including the doctors, had lunch breaks every day. Burning out is a serious issue for people in our profession, and reasonable work days with breaks is a small step that we can take. We recognize that it will never be perfect; emergencies happen, sick team members call out, and so forth. But, prioritizing legitimate breaks — above and beyond the five minutes spent wolfing down caffeine and a sandwich in the treatment room — is crucial. Efficient workflow is necessary to give breaks to each team member.

Addressing Responsibility and Communication

Once we were on the same page about the overall focus, it was time to start looking at responsibility. This is a very uncomfortable part of the process, but the managers and doctors are responsible for the hospital's direction, so when things are going poorly, we need to look at our contributions to the problem. Communication — or lack thereof — is almost always the main factor. But, all issues have multiple roots, and we really need to be willing to dig them up, like:

Lack of leadership. Sometimes managers and doctors who are uncomfortable with confrontation, and the resulting leaderless teams, have a lack of direction.

Underperformers. It's also possible that the issue lies with team members who are not doing the work we need done, so we need to clarify the practice's priorities for them.

I want to stress this is not a blame game — blame is a useless approach that will drive guilt, not progress. When the problem at hand is high stress and burnout, we owe it to our teams to work on that.

In our practices, we drive protocol change because we want to do better. Whether it's in response to medical evidence, technology improvements, and outside economic forces, or simply a need to improve current protocols, managers and doctors are responsible for identifying the need for change. Identify the multiple roots of the issue and create workable goals with your doctors. It's their responsibility to actively support the goals, which will drive the protocol changes needed within the practice.

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Nancy Drumm
General Manager, Capital Vets

Nancy Drumm is the daughter of a veterinarian and the granddaughter of a dairy farmer. She started working at the family practice at the age of 8, helping her father see patients after dinner, and the practice has been part of her entire life. She has been a farmer for many years as well. She has a burning interest in how things work and enjoys the challenges of running a business. She combines that curiosity and a willingness to try new things with a desire to use data to help us all make better decisions for our lives and practices.

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